Healthcare Provider Details

I. General information

NPI: 1306107206
Provider Name (Legal Business Name): ERIC B PIERCE O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 OVERLAND AVE
BURLEY ID
83318-2439
US

IV. Provider business mailing address

1970 OVERLAND AVE
BURLEY ID
83318-2439
US

V. Phone/Fax

Practice location:
  • Phone: 208-678-3539
  • Fax:
Mailing address:
  • Phone: 208-678-3539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODP-100249
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: